Inspection Reports for
Carmela Homes
5500 Cleary Ct., Las Vegas, NV 89108, NV, 89108
Back to Facility Profile19 Reports
Inspection Report — Sep 11, 2024
Annual Inspection
Date: Sep 11, 2024
Visit Reason
The inspection was conducted as an annual State Licensure survey of the facility on 09/11/2024 in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility failed to ensure that six-month pharmacy medication reviews for all six residents were reviewed and initialed by the Administrator as required by regulation. The Administrator's signature or initials were missing from the documentation for all residents' medication reviews.
Deficiencies (1)
Failure to ensure six-month pharmacy medication reviews were reviewed and initialed by the Administrator for all six residents.
Report Facts
Inspection Report — Aug 23, 2023
Annual Inspection
Date: Aug 23, 2023
Visit Reason
This inspection was conducted as an annual State Licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility received a grade of A. Deficiencies were identified related to medication labeling, cultural competency training for employees, and policies regarding resident preferred names and pronouns. Corrective actions were planned and scheduled for completion by 09/20/2023.
Deficiencies (3)
Facility failed to ensure all medications for 1 of 6 residents were properly labeled with resident's name, prescribing physician, and directions for use.
Facility failed to ensure 1 of 4 employees were in compliance with initial cultural competency training requirements.
Facility failed to develop policies and revise resident records to reflect gender identity or expression and preferred name as required.
Report Facts
Medication boxes removed: 9
Employee files reviewed: 4
Resident files reviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Belma Dizon | Managing Member | Named as Laboratory Director's or Provider/Supplier Representative who signed the report |
| Employee #2 | Confirmed medication labeling deficiencies and cultural competency training status | |
| Employee #3 | Caregiver | Employee lacking initial cultural competency training at time of survey |
| Employee #1 | Confirmed lack of updated policies or changes to resident records regarding gender identity and preferred name |
Inspection Report — Aug 30, 2022
Annual Inspection
Date: Aug 30, 2022
Visit Reason
The inspection was conducted as an annual State Licensure and infection control survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
Two regulatory deficiencies were identified: failure to conduct COVID-19 screening for a surveyor upon entry, and failure to ensure a medication lock box in the refrigerator was locked. Both deficiencies were assigned a severity level of 2 and scope of 3.
Deficiencies (2)
Facility failed to ensure a COVID-19 screening was conducted for a surveyor entering the facility; screening questionnaire was not provided and temperatures were not taken.
Facility failed to ensure a medication lock box in the refrigerator was locked; the lock box was unlocked with the key in the lock.
Report Facts
Licensed beds: 6
Employee files reviewed: 4
Resident files reviewed: 6
Deficiency severity count: 2
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Belma Dizon | Owner | Signed as Laboratory Director's or Provider/Supplier Representative |
Inspection Report — Oct 7, 2021
Annual Inspection
Date: Oct 7, 2021
Visit Reason
The inspection was conducted as an annual State Licensure and infection control survey of a Residential Facility for Groups in accordance with Nevada Administrative Code Chapter 449.
Findings
The facility received a grade of A. Deficiencies were identified related to failure to ensure two-step tuberculosis testing was completed for 2 of 6 sampled residents. The Owner/Caregiver acknowledged the lack of documented evidence for the initial two-step TB test for these residents.
Deficiencies (1)
Failure to ensure two-step tuberculosis (TB) testing was completed for 2 of 6 sampled residents (Residents #3 and #5).
Report Facts
Resident files reviewed: 6
Employee files reviewed: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Belma Dizon | Director | Signed as Laboratory Director's or Provider/Supplier Representative |
Inspection Report — Oct 27, 2020
Routine
Date: Oct 27, 2020
Visit Reason
The inspection was a COVID-19 focused infection control, State Licensure survey initiated at the facility on 10/27/2020 in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
The facility was found to have adequate infection control practices overall, including mask use, social distancing, hand hygiene, and sanitizing protocols. However, the Administrator failed to ensure availability and fit testing of N95 respirators for staff, which was a cited deficiency.
Deficiencies (1)
Administrator failed to practice safe infection control practices related to COVID-19; N95 respirators were not available and no caregivers were medically cleared or fit tested to use N95 respirators.
Report Facts
Licensed beds: 6
Hand sanitizer bottles: 10
Gloves: 400
Surgical style masks: 100
Severity: 2
Scope: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Belma Dizon | Director | Signed as Laboratory Director or Provider/Supplier Representative |
Inspection Report — Oct 17, 2019
Annual Inspection
Date: Oct 17, 2019
Visit Reason
This inspection was conducted as an annual State licensure survey in accordance with Nevada Administrative Code Chapter 449 for Residential Facilities for Groups.
Findings
The facility received a grade of A with no regulatory deficiencies identified. Six resident files and three employee files were reviewed during the survey.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 3
Inspection Report — Nov 14, 2018
Annual Inspection
Date: Nov 14, 2018
Visit Reason
Annual State Licensure survey conducted in accordance with Nevada Administrative Code Chapter 449 for Residential Facility for Groups.
Findings
Two deficiencies were identified: a loose water faucet in one bathroom that needed repair, and failure to perform annual Activities of Daily Living (ADL) assessments for 5 of 6 residents residing longer than a year.
Deficiencies (2)
Bathroom faucet in bedroom #4 was loose and needed repair.
Facility failed to perform annual ADL evaluations for 5 of 6 residents.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 4
Residents lacking annual ADL assessment: 5
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Marina Vaughn | Administrator | Signed the report and identified as administrator |
| Employee #1 confirmed faucet was loose and was unaware of annual ADL assessment requirement |
Inspection Report — Apr 3, 2018
Complaint Investigation
Date: Apr 3, 2018
Visit Reason
The inspection was conducted as a complaint investigation triggered by Complaint #NV00052590 alleging insufficient and poor quality food served at the facility.
Complaint Details
Complaint #NV00052590 alleged the facility serves only hot dogs or noodles every night for dinner and that the food was insufficient and did not taste good. The complaint was not substantiated.
Findings
The investigation included interviews with residents and the Administrator, review of food inventory and menus. The allegation was not substantiated and no regulatory deficiencies were identified.
Report Facts
Sample size: 3
Complaint count: 1
Inspection Report — Nov 6, 2017
Annual Inspection
Date: Nov 6, 2017
Visit Reason
This inspection was conducted as an annual State Licensure survey of the facility on 11/6/17 by the Division of Public and Behavioral Health.
Findings
The facility received a grade of A with no deficiencies identified at the time of the survey. Six resident files and four employee files were reviewed.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 4
Inspection Report — Oct 11, 2016
Annual Inspection
Date: Oct 11, 2016
Visit Reason
This Statement of Deficiencies was generated as a result of an annual State Licensure survey conducted in the facility on 10/11/16 by the Division of Public and Behavioral Health.
Findings
The facility received a grade of A with no regulatory deficiencies identified at the time of the survey.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 4
Inspection Report — Nov 18, 2015
Annual Inspection
Date: Nov 18, 2015
Visit Reason
This inspection was conducted as an annual State Licensure survey to assess compliance with state regulations for a residential facility for elderly and disabled persons and/or persons with mental illness.
Findings
The facility received a grade of A but had deficiencies including failure to maintain cleanliness and proper maintenance of the premises, and failure to ensure destruction of discontinued or expired medications for three residents.
Deficiencies (2)
Failure to ensure the facility was clean and the interior of the home was well maintained, with observations including debris and broken furniture in the backyard.
Failure to ensure discontinued or expired medication was destroyed for Residents #1, #4, and #5.
Report Facts
Resident files reviewed: 5
Employee files reviewed: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Employee #4 acknowledged findings related to facility maintenance deficiencies | ||
| Employee #1 acknowledged expired medication had not been destroyed |
Inspection Report — Nov 16, 2015
Annual Inspection
Date: Nov 16, 2015
Visit Reason
The inspection was an annual State Licensure survey conducted to assess compliance with health and sanitation regulations and medication administration standards.
Findings
The facility was found to have deficiencies related to cleanliness and maintenance of the premises, including debris and broken items in the backyard and storage areas, as well as medication destruction failures for expired or discontinued medications for multiple residents.
Deficiencies (2)
Failure to maintain clean and well-maintained premises, including debris and broken items in the backyard and storage areas.
Failure to ensure destruction of expired or discontinued medications for residents.
Report Facts
Deficiency severity: 2
Deficiency scope: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Employee #4 | Acknowledged findings related to premises maintenance | |
| Employee #1 | Acknowledged expired medication had not been destroyed |
Inspection Report — Nov 25, 2014
Annual Inspection
Date: Nov 25, 2014
Visit Reason
This document reports on an annual State Licensure survey conducted at the facility on 11/25/2014 by the Division of Public and Behavioral Health.
Findings
The facility received a grade of A with no regulatory deficiencies identified at the time of the survey.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 4
Inspection Report — Dec 20, 2013
Annual Inspection
Date: Dec 20, 2013
Visit Reason
The inspection was conducted as a State Licensure annual grading survey of the facility on 12/20/2013.
Findings
The facility received a grade of A. One deficiency was identified related to personnel files: the facility failed to ensure that one of four employees met background check requirements as required by NRS 449.
Deficiencies (1)
Failed to ensure 1 of 4 employees met background check requirements; Employee #3 did not have evidence of a background check initiated within 10 days of hire.
Report Facts
Number of residents present: 5
Number of employees reviewed: 5
Number of resident files reviewed: 5
Inspection Report — Nov 6, 2012
Date: Nov 6, 2012
Visit Reason
This Statement of Deficiencies was generated as a result of a self-attestation questionnaire completed by the facility in lieu of a 2012 annual survey.
Findings
The facility is licensed for six Residential Facility for Group beds for elderly and disabled persons. The questionnaire indicated the facility was in regulatory compliance and will receive the grade of A. No further action is necessary.
Inspection Report — Dec 21, 2011
Annual Inspection
Date: Dec 21, 2011
Visit Reason
This document is an annual State Licensure survey conducted to assess compliance with regulatory requirements for Carmela Homes, a residential facility for elderly and disabled persons.
Findings
The facility received a grade of A but was found deficient in maintaining cleanliness and upkeep of the premises, specifically a resident bathroom faucet needing replacement due to calcium and lime buildup, and failure to conduct monthly evacuation drills and smoke detector tests for one month.
Deficiencies (2)
Facility failed to ensure the premises were clean and well maintained; resident bathroom faucet needed replacement due to calcium and lime buildup.
Facility did not ensure monthly evacuation drills and smoke detector tests were conducted for one month (missing January 2011).
Report Facts
Deficiency scope: 3
Employees mentioned
| Name | Title | Context |
|---|---|---|
| BD | Initials of the person who signed the plan of correction on 12/23/2011 and 01/16/2012 |
Inspection Report — Nov 5, 2010
Annual Inspection
Date: Nov 5, 2010
Visit Reason
This document is the result of an annual State Licensure survey conducted at the facility on 11/5/2010 to assess compliance with state regulations.
Findings
No regulatory deficiencies were identified during the inspection. The facility received a grade of A and no further action was necessary.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 3
Discharged resident files reviewed: 1
Inspection Report — Nov 16, 2009
Annual Inspection
Date: Nov 16, 2009
Visit Reason
This document reports the results of an annual State Licensure survey conducted at the facility on 11/16/2009 to assess compliance with state regulations for residential facilities.
Findings
No regulatory deficiencies were identified during the survey. The facility was found to be in full compliance and received a grade of A.
Report Facts
Resident files reviewed: 6
Employee files reviewed: 3
Discharged resident files reviewed: 1
Inspection Report — Nov 7, 2008
Annual Inspection
Date: Nov 7, 2008
Visit Reason
This annual state licensure survey was conducted to assess compliance with Nevada Administrative Code (NAC) 449, Residential Facility for Groups Regulations, for Carmela Homes.
Findings
The facility was found deficient in multiple areas including caregiver training, personnel file maintenance, tuberculosis testing and surveillance, provision of resident activities, medication administration reviews, documentation of PRN medication results, and incomplete resident files.
Deficiencies (8)
Failed to ensure eight hours of annual training related to resident needs for 1 of 4 employees.
Failed to maintain separate personnel files for 2 of 4 employees.
Failed to ensure tuberculosis testing was completed for 3 of 4 employees.
Failed to provide 10 hours of scheduled activities per week for all 6 residents.
Failed to ensure medication reviews were obtained every 6 months for 3 of 6 residents.
Failed to document the results of PRN medication administration for 1 of 5 residents.
Failed to ensure proper tuberculosis skin testing or surveillance for 4 of 6 residents.
Failed to maintain complete resident files including rate agreements, physician statements, protective supervision documentation, and signed house rules for 6 of 6 residents.
Report Facts
Residents present: 6
Licensed beds: 6
Employees reviewed: 4
Residents reviewed: 6
Deficiencies with medication review: 3
Residents lacking TB testing: 4
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Employee #1 | Acknowledged follow-up documentation required for medication administration; indicated no rate agreements due to pay source | |
| Employee #2 | Administrator | Hired 8/9/95; lacked documented evidence of annual 8-hour training and TB surveillance for past two years |
| Employee #3 | Personnel file not maintained separately | |
| Employee #4 | Personnel file not maintained separately |
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